THE ROLE OF ROUTINE LABORATORY TESTING IN THE MANAGEMENT OF CHRONIC URTICARIA

Abstract

Objective: The diagnosis of chronic spontaneous urticaria (CSU) is mainly based on a thorough patient history and physical examination. Although limited laboratory tests are recommended, detailed screening laboratory tests are frequently required by specialists to exclude underlying diseases or to identify causative factors. The aim of this study was to evaluate laboratory findings of patients with CSU and its impact on the diagnosis and management of the disease. Material and Method: The demographic and clinical findings, laboratory tests, and treatment regimens of patients diagnosed as CSU were evaluated. Results: A total of 113 (61 M, 52 F) cases with CSU were evaluated. The median age of the patients was seven years (IQR: 7-10). Among 911 ordered tests, only 156 (17.1%) were found abnormal. The most common abnormalities were detected in the complete blood count tests. Eighty-three (73.4%) of 156 patients, were receiving the first step treatment. Laboratory test results did not affect or cause any alterations in the treatment regimen of the patients. Conclusion: Although detailed laboratory tests did not change the course of urticaria in patients with CSU, laboratory tests can be planned considering the personal characteristics of each patient.

Keywords

• Chronic spontaneous urticaria
• autoantibody
• blood test

KRONİK ÜRTİKER YÖNETİMİNDE RUTİN LABORATUVAR TESTLERİNİN YERİ

Abstract

Amaç: Kronik spontan ürtiker (KSÜ) tanısı, esas olarak detaylı alınmış bir öykü ve fizik muayene ile konulur. Tanı için sınırlı sayıda laboratuvar testlerinin yapılması önerilir. Ancak altta yatan hastalıkları dışlamak ve/veya neden olan faktörleri belirlemek amacı ile uzmanlar tarafından sıklıkla laboratuvar testleri önerilenden daha fazla istenmektedir. Çalışmamızda KSÜ tanılı hastalarda laboratuvar bulgularının hastalığın tanısı ve yönetimi üzerine olan etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Kronik spontan ürtiker tanısı konulan hastaların demografik ve klinik bulguları, laboratuvar test sonuçları ve tedavileri değerlendirildi. Bulgular: Kronik spontan ürtikerli toplam 113 hasta (61 E, 52 K) değerlendirildi. Medyan yaş 7 yıl, (çeyrekler arası açıklığı; IQR 7-10) idi. Toplam 911 testten sadece 156’sı (%17,1) anormal idi. En sık anormallik tam kan sayımında saptandı. Hastaların 83’ü (%73,4) birinci basamak tedavi almakta idi. Laboratuvar test sonuçları hiçbir hastanın tedavisini etkilemedi ve tedavi protokollerinde bir değişiklik yapılmasına neden olmadı. Sonuç: Detaylı olarak yapılan laboratuvar testleri KSÜ’li hastalarda ürtikerin seyrini değiştirmese de laboratuvar tetkikleri her hastanın kişisel özellikleri göz önüne alınarak planlanabilir.

Keywords

• Kronik spontan ürtiker
• otoantikor
• kan testleri

References

1. 1. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, et al. The EAACI/GA²LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy 2018;73(7):1393-414. [CrossRef]
2. 2. Kudryavtseva AV, Neskorodova KA, Staubach P. Urticaria in children and adolescents: An updated review of the pathogenesis and management. Pediatr Allergy Immunol. 2019;30(1):17-24. [CrossRef]
3. 3. Cornillier H, Giraudeau B, Munck S, Hacard F, Jonville- Bera AP, d’Acremont G, Pham BN, Maruani A. Chronic spontaneous urticaria in children - a systematic review on interventions and comorbidities. Pediatr Allergy Immunol 2018;29(3):303-10. [CrossRef]
4. 4. Radonjic-Hoesli S, Hofmeier KS, Micaletto S, Schmid- Grendelmeier P, Bircher A, Simon D. Urticaria and angioedema: an update on classification and pathogenesis. Clin Rev Allergy Immunol 2018;54(1):88-101. [CrossRef]
5. 5. Shahzad Mustafa S, Sánchez-Borges M. Chronic Urticaria: Comparisons of US, European, and Asian Guidelines. Curr Allergy Asthma Rep 2018;18(7):36. [CrossRef]
6. 6. Azkur D, Civelek E, Toyran M, Mısırlıoğlu ED, Erkoçoğlu M, Kaya A, Vezir E, Giniş T, Akan A, Kocabaş CN. Clinical and etiologic evaluation of the children with chronic urticaria. Allergy Asthma Proc 2016;37(6):450-7. [CrossRef]
7. 7. Arik Yilmaz E, Karaatmaca B, Cetinkaya PG, Soyer O, Sekerel BE, Sahiner UM The persistence of chronic spontaneous urticaria in childhood is associated with the urticaria activity score. Allergy Asthma Proc 2017;38(2):136-42. [CrossRef]
8. 8. Tarbox JA, Gutta RC, Radojicic C, Lang DM. Utility of routine laboratory testing in management of chronic urticaria/angioedema. Ann Allergy Asthma Immunol 2011;107(3):239-43. doi: 10.1016/j.anai.2011.06.008. Epub 2011 Jul 20. [CrossRef]

9. 9. Lo SF. Reference Intervals for Laboratory Tests and Procedures. In Kliegman RM. St Geme JW 3rd, Blum NJ, Shah SS, Tasker RC, Wilson KM, Behrman RE, Brunton LB, editors. Nelson Textbook of Pediatrics, 21 eds. Philadelphia: Elsevier; 2020. P 5368-76.
10. 10. Młynek A, Zalewska-Janowska A, Martus P, Staubach P, Zuberbier T, Maurer M. How to assess disease activity in patients with chronic urticaria? Allergy 2008;63(6):777-80. [CrossRef]
11. 11. Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014;133(5):1270-7. [CrossRef]
12. 12. Kilic G, Guler N, Suleyman A, Tamay Z. Chronic urticaria and autoimmunity in children. Pediatr Allergy Immunol 2010; 21(5):837-42. [CrossRef]
13. 13. Lee N, Lee JD, Lee HY, Kang DR, Ye YM. Epidemiology of chronic urticaria in Korea using the Korean Health Insurance Database, 2010-2014. Allergy Asthma Immunol Res 2017;9(5):438-45. [CrossRef]
14. 14. Sahiner UM, Civelek E, Tuncer A, et al. Chronic urticaria: etiology and natural course in children. Int Arch Allergy Immunol 2011;(156):224-30. [CrossRef]
15. 15. Lee SJ, Ha EK, Jee HM, Lee KS, Lee SW, Kim MA, et al. Prevalence and risk factors of urticaria with a focus on chronic urticaria in children. Allergy Asthma Immunol Res 2017;9(3):212-9. [CrossRef]
16. 16. Bansal CJ, Bansal AS. Stress, pseudoallergens, autoimmunity, infection and inflammation in chronic spontaneous urticaria. Allergy Asthma Clin Immunol 2019;15:56. [CrossRef]
17. 17. Cornillier H, Giraudeau B, Samimi M, Munck S, Hacard F, Jonville-Bera AP, et al. Effect of diet in chronic spontaneous urticaria: A systematic review. Acta Derm Venereol 2019;99(2):127-32. [CrossRef]
18. 18. Goodman DL, McDonnel JT, Nelson HS, Vaughan TR, Weber RW. Chronic urticaria exacerbated by the antioxidant food preservatives, butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT). J Allergy Clin Immunol 1990;86(4 Pt 1):570-5. [CrossRef]
19. 19. Kumar YH, Bhaskar S, Shankar K. Comparative study of positive versus negative autologous serum skin test in chronic spontaneous urticaria and its treatment outcome. N Am J Med Sci 2016;8(1):25-30. [CrossRef]
20. 20. Boonpiyathad T, Sangasapaviliya A. Autologous serum and plasma skin test to predict 2-year outcome in chronic spontaneous urticaria. Asia Pac Allergy 2016;6(4):226-35. [CrossRef]
21. 21. Kim YS, Han K, Lee JH, Kim NI, Roh JY, Seo SJ et al. Increased risk of chronic spontaneous urticaria in patients with autoimmune thyroid diseases: A nationwide, population based study. Allergy Asthma Immunol Res 2017;9(4):373-7. [CrossRef]
22. 22. Konstantinou GN, Asero R, Maurer M, Sabroe RA, Schmid- Grendelmeier P, Grattan CE. EAACI/GA(2)LEN task force consensus report: the autologous serum skin test in urticaria. Allergy 2009;64(9):1256-68. [CrossRef]
23. 23. Kaplan AP. Diagnosis, pathogenesis, and treatment of chronic spontaneous urticaria. Allergy Asthma Proc 2018;39(3):184-90. [CrossRef]
24. 24. Kolkhir P, Balakirski G, Merk HF, Olisova O, Maurer M. Chronic spontaneous urticaria and internal parasites--a systematic review. Allergy 2016;71(3):308-22. doi: 10.1111/ all.12818. Epub 2015 Dec 28. [CrossRef]
25. 25. Akelma AZ, Cizmeci MN, Mete E, Tufan N, Bozkurt B. A neglected cause for chronic spontaneous urticaria in children: Helicobacter pylori. Allergol Immunopathol (Madr) 2015;43(3):259-63. [CrossRef]